Megan Henken

Cleaning and disinfection priorities in healthcare often focus on surfaces. And yet, many life-threatening pathogens are spread through the air requiring different protocols, equipment and considerations.

With healthcare-acquired infections rising significantly during the pandemic, there’s a renewed focus on preventing the spread of pathogens: primarily viruses, bacteria and fungi. The challenge is that not all pathogens are alike, and different organisms transmit differently to humans.

In fact, there are four primary ways that pathogens spread to humans: 

  • Directly, typically from hands
  • Indirectly, from surfaces
  • Through droplets, often from sneezing or coughing
  • Through aerosolized particles

Staphylococcus aureus, a nosocomial pathogen that can live on surfaces for months, is commonly spread when someone touches a contaminated surface. Tuberculosis and COVID-19 particles are airborne and inhaled.

Airborne particles are often overlooked

Despite the different ways that pathogens spread, the majority of infection prevention practices, protocols and guidelines are surface-driven. For example, the U.S. Centers for Disease Control (CDC) cleaning protocols focus on high touch surfaces, and many environmental service (EVS) teams adhere to guidelines that also promote surface cleaning – emptying the trash can, high dusting, surface disinfection and mopping.

The focus on surface pathogens is understandable: It’s easy to see the importance of cleaning a surface when there is visible soil and yet, if you’re only concentrating on protocols and best practices for cleaning surfaces, you’re not addressing all of the pathogens and the different ways that they spread.

Cleaning vs. disinfection

So how do you eliminate the pathogens that you are not killing through your normal cleaning practices?

First, it’s important to recognize that cleaning a surface does not necessarily equate disinfection. People are more attuned to visible cleaning than disinfection. And even on surfaces, it tends to be tricky. Cleaning removes dirt and organic matter from surfaces, while disinfecting focuses on killing pathogens such as viruses and bacteria on surfaces. When a surface is cleaned with a cloth, the pathogen remains on the cloth. Actually killing a pathogen requires a disinfectant. This concept applies to the air as well.

Most standard air purifiers remove particles from the air, but they don’t necessarily eliminate the particles or pathogens.  For example, some electronic air purifiers utilize ionization to break down molecular contaminants and move them out of the “breathing zone,” which is the area immediately surrounding a worker’s nose and mouth where the majority of air is drawn into their lungs. However, this method simply moves pathogens and does not kill them. In fact, this method has been found to emit harmful organic compounds, such as acetone, ethanol and toluene – substances commonly found in paint strippers, aerosol sprays and pesticides – as well as ozone, which can cause throat irritation, coughing, chest pain and shortness of breath. Using other technologies in conjunction with a HEPA filter, such as (ultraviolet) UV radiation, will assist with actually killing and destroying aerosolized pathogens. It’s also critical that the purifier can absorb extremely small particles, and has the capacity to cover the full area of a room or facility.

Assessing air filtration systems 

Adequate air purification is especially important in long-term care (LTC) facilities where residents are more susceptible to infection. To help long-term care providers make air quality upgrades, facilities can apply for civil monetary penalty (CMP) reinvestment funds through the Centers for Medicare & Medicaid Services to purchase portable fans and air room cleaners with high-efficiency particulate air (HEPA) filters to increase or improve air quality.  

Before purchasing an air purification system or device, it’s important to understand what you’re buying and what you are trying to accomplish. Among the questions to ask:

  1. What different components make up the air purification system? Is there strictly a HEPA filter? Or, is there a carbon filter or UV radiation component specifically designed to destroy pathogens? How often does the filter need to be changed?
  2. What is the air surface coverage of the device? Is it sufficient for the space you are trying to disinfect? The air surface coverage will impact where you place the device, and how long it will need to run.
  3. What is the system’s log reduction – the measure of how thoroughly the system reduces pathogens and contaminants?  A five log system, for example, kills 99.999% of pathogens. 
  4. What is the smallest size particle that the system can remove? An effective system can remove particles as small as .1 to .3 microns.
  5. Can the system improve air quality by removing odors along with pathogens?
  6. What are the efficacy studies that support the claims made by the manufacturer? Was the research conducted in a certified lab? If you are looking to kill COVID-19, the system will need to go beyond U.S. Environmental Protection Agency (EPA) standards.
  7. Are the device’s registrations up to date? Many states have EPA pesticide device standards and may require product manufacturer registration.

It is possible to manage and destroy airborne pathogens in your healthcare setting with an appropriate filtration system or air purifier. As the number and type of pathogens continue to evolve, having a comprehensive cleaning and disinfection protocol that takes into consideration all of the ways that pathogens spread will be critical to avoiding and managing the next big disease outbreak. 

Megan Henken is the vice president of EVS Product Management for Medline.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.